Breathe easy? Not so for injured Sox

By Gary Gillis / Special to MLB.com

If you've been a Red Sox fan for a good long time, or somewhat familiar with the franchise history, then you are aware of the painful nature of some past seasons. While those seasons created emotional wounds, you would have to admit that two World Series championships in the last six years have gone a long way in easing any pain.

But this season is about physical pain. And the Red Sox have had more than their share. Jacoby Ellsbury may just be the poster boy. The Red Sox lost his services way back on April 11, when Ellsbury came out on the losing end of a collision with Adrian Beltre as both were pursuing a pop foul. Ellsbury took a knee to his side and a spot on the DL with fractured ribs.

According to Dr. Jennifer Pope, an emergency medicine physician at Beth Israel Deaconess Medical Center, collisions are a common cause of rib fractures. But most often those collisions involve motor vehicles.

"We do see a lot of patients who come into the emergency department with broken ribs as a result of car accidents or motorcycle accidents," said Pope. "The most common cause is blunt force trauma."

Beltre's knee is certainly blunt and can be applied with force. Jeremy Hermida is another teammate who learned that the hard way. Even when the injury is a contusion and not a fracture the discomfort level is about the same. When it comes to pain, Pope says that broken ribs are the gift that just keeps on giving.

"It's an extremely painful injury. Certainly a player would be unable to swing a bat without severe discomfort," said Pope. "Sneezing and coughing can literally bring you to tears. Putting on a shirt or blouse is a problem. Pain control is really at the top of the list when treating rib fractures."

You can't immobilize a rib with a cast and the old approach of taping up the chest really offers little benefit. Making the patient comfortable is sometimes the best you can do. Along with non-steroidal anti-inflammatory medications like ibuprofen or naproxen, narcotics might be needed just to allow the patient to breathe properly.

"Each breath is an expansion and contraction of the rib cage," said Pope. "If that's too painful, the patient will end up taking very shallow breaths. That can lead to a condition called atelectasis. When we don't fully inflate the tiny alveoli -- the air sacs in our lungs -- it can cause part of the lung to collapse, make it easier for fluid to collect in the lungs and increase the chance of pneumonia. We often send people home with an incentive spirometer. It's a device that measures the volume of air that you inhale. Patients use this several times a day to get feedback on just how fully they are inflating their lungs."

Generally it takes about six weeks for a rib fracture to heal. As the pain and discomfort diminish, patients are encouraged to increase their activity (but no sports for about three weeks). Ellsbury did make a brief return in late May, but a diving catch led to a setback in his recovery. An MRI revealed a previously undiscovered rib fracture. Diving catches are an occupational hazard for outfielders. Perhaps we'll see him back in these parts in mid-to-late July.

Chances are, you are not going to face the same risks where you work or live, but even a trip over a rug or off a curb can lead to an injury-inducing fall.

"In most cases, a fractured rib isn't one of those injuries that you can prevent by building up your muscles or stretching or wearing protective equipment," said Pope. "It is avoidable sometimes with a little caution and common sense, but not always."

Accidents do happen -- in the home, in a car and in the outfield.

Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.